U.S. Waistlines Continue to Bulge

Action Points

Explain to patients that lifestyle factors contributing to obesity include increases in daily calorie consumption, more eating out and larger portion sizes in restaurants, consumption of more sugary beverages, increased time spent in front of computers and televisions, and lack of physical activity.

Overcome any reluctance to inform parents of overweight or obese children of their childâ€™s weight status.

HYATTSVILLE, Md., April 4 - More American children, adolescents, and men have swelled the ranks of the overweight or obese since 1999, according to new federal statistics.

However, the decades-long trend of increasing obesity may be leveling off among women, reported Cynthia L. Ogden, Ph.D., and colleagues of the CDCâ€™s National Center for Health Statistics here in the April 5 issue of the Journal of the American Medical Association.

Dr. Ogden and colleagues examined the most recent data from the National Health and Nutrition Examination Survey (NHANES), obtained during 2003-2004. The data included height and weight measurements of nearly 4,000 U.S. children and adolescents and about 4,400 U.S. adults.

Overall, 17% of children and adolescents were overweight in 2003-2004, up from nearly 14% in 1999-2000. And 32% of adults were obese in 2003-2004, up from 30.5% in 1999-2000.

The prevalence of overweight female children and adolescents increased from nearly 14% in 1999-2000 to 16% in 2003-2004. For male children and adolescents, the figure rose from 14% to 18%.

Among men, the prevalence of obesity increased from 27.5% in 1999-2000 to 31% in 2003-2004. Among women, however, that figure remained static at 33%.

It was not clear whether the apparent leveling off of obesity among women was real. "Weâ€™ll need more data to confirm thatâ€™s the case," Dr. Ogden said, noting that the current study covers a period of only six years.

And even if the trend is confirmed, "there are still one-third of American women who are obese," she added.

U.S. lifestyle factors that have contributed to the obesity epidemic include increases in daily calorie consumption, more eating out and larger portion sizes in restaurants, consumption of more sugary beverages (specially among children), increased time spent in front of computers and televisions, and lack of physical activity, Dr. Ogden said.

One factor that may hinder the fight against obesity is doctorsâ€™ reluctance to inform children or their parents that a child is overweight, Dr. Ogden said. In a study she helped author last year, only about half (52%) of overweight teens were informed of their overweight status by a doctor.

For parents of very young children (ages two to five), only 17% of those with overweight children were told by clinicians their child was overweight, â€œpossibly suggesting reluctance by health-care providers to inform parents of the weight status of very young overweight children,â€ Dr. Ogden and colleagues wrote in the Sept. 2, 2005, issue of Morbidity and Mortality Weekly Report.

"Early recognition and discussion of overweight status is a necessary first step to developing healthier lifelong behaviors,â€ Dr. Ogden and colleagues wrote. "Addressing overweight among children and teens requires recognition by health-care providers, discussion of potential consequences with families, acknowledgment of those consequences by families of affected children, and a commitment to work together toward attaining a healthier lifestyle."

Other highlights from the current study include:

Extreme obesity (a body-mass index of 40 or greater) remained level during the study period. The prevalence of extreme obesity in men was 2.8% in 2003-2004, compared with 3.1% in 1999-2000. For women, the current figure was 6.9%, compared with 6.3% in 1999-2000.

Approximately 30% of white adults, 45% of black adults, and nearly 37% of Mexican Americans were obese in 2003-2004.

Risk of obesity increased with age. Men and women age 40 to 79 were two to nearly three times more likely than those age 20 to 39 to be obese. In 2003-2004, 28.5% of adults age 20 to 39 were obese, compared with nearly 37% of those age 40 to 59 and 31% of those age 60 years or older.

Data from the World Health Organization and others show that increasing weight gain is not a phenomenon limited to the United States. For example, the prevalence of obesity among adults in Great Britain nearly tripled between 1980 and 2002. And among preschool children in urban areas of China, the prevalence of obesity has increased from 1.5% in 1989 to 12.6% in 1997, Dr. Ogden and colleagues noted.

'It's happening around the world," Dr. Ogden said. "We are not alone in this."

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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